- Doctors can incorporate advance care planning discussions as a routine part of care.
- Raise, with all appropriate patients, the issue of planning ahead if things get worse.
- Ideally, begin advance care planning discussions slowly and over time.
- Initially, these conversations can be a time to explore attitudes without focusing on any particular g treatment (e.g. I know that many patients have concerns about controlling the use of a medical treatment if things got worse. Are there issues or concerns you want to talk about with me?).
- Ensure patients understand their illness and the benefits and burdens of current treatments and possible future treatments.
- Explore questions with patients regarding benefits and burdens of treatments in the context of their goals, values, religious and cultural beliefs.
- Identify who would make health care decisions on their behalf if they were unable to speak for themselves.
- Invite the designated substitute decision maker into the discussions.
- Witness relevant documents where applicable.
- The designation of a substitute decision maker (the title differs depending upon the legislation in each state and territory), is an important advance care planning issue that should be discussed and documented. Then, even in the absence of other instructions, an appropriate decision maker has been identified.
- Emphasise that the substitute would only be making decision if the patient was no longer competent.
- Discuss with the patient and if possible, their substitute decision maker what their goals for medical care would be.
- For example, would the patient want aggressive treatment to sustain their lives, or would they want the primary focus to be comfort? Discuss the option of trials of treatment.
- Document discussions
- Documentation of advance care planning can be via a letter, discharge information, a Statement of Choices or an Advance Health Directive –this differs between States and Territories.
- Incorporate patient’s choices into medical care plans
- For example, if a patient has requested not to be resuscitated, complete an NFR (Not for Resuscitation) or DNR (Do Not Resuscitate) form if applicable.
- Review patient's choices periodically
- As patients choices may change over time, or become more specific, especially as their illness progresses, it is important to ensure that previous choices are re-visited.
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